No abstract

No abstract

No abstract

We examine multi-generational impacts of positive in utero and early life health interventions. We focus on the 1980s Medicaid expansions, which targeted low-income pregnant women, and were adopted differently across states and over time. We use Vital Statistics Natality files to create unique data linking individuals' in utero Medicaid exposure to the next generation's health outcomes at birth. We find strong evidence that the health benefits associated with treated generations' in utero access to Medicaid extend to later offspring in the form of higher average birth weight and decreased incidence of very low birth weight. Later childhood exposure to Medicaid does not lead to persistent health effects across generations. The return on investment is substantially larger than suggested by evaluations of the program that focus only on treated cohorts. There is substantial evidence that health and socioeconomic inequalities persist across generations. A growing number of studies suggest that differences in early life health environments may causally contribute to these disparities. Negative shocks to the in utero environment, in particular, have been found to be harmful to individuals' later life health and earnings. A handful of studies also examine positive interventions and find that policies intended to improve early life experiences generate better adult outcomes.1 By extension, literatures in economics, epidemiology and child development predict that the causal impacts of these interventions should echo beyond the exposed generation. Little is known, however, about the extent to which the early life environment impacts future generations, or the potential for public policy to alter such linkages.We consider whether positive public health interventions experienced in utero and during childhood subsequently affect the next generation's health. We focus on the impact of the largest source of health-related services for low-income children in the United States: the Medicaid Program. Changes in eligibility rules during the 1980s and 1990s, particularly for lowincome pregnant women and children who were not otherwise tied to the welfare system, led to a dramatic increase in individuals' prenatal and early childhood Medicaid eligibility. 2 The additional coverage provided to pregnant women under the expansions represents the single largest effort the federal government has ever made to improve birth outcomes. There was considerable variation in the timing and magnitude of these expansions across states, which prior empirical research has harnessed to examine the program's effects on cohorts who gained access 1 See Currie (2011a,2011b) 1 in utero and during childhood. 3 We build on research documenting effects on the "first generation," to investigate whether positive policy interventions in one generation transmit to the next generation.Our analyses make several contributions to the literature relating the early life environment to later outcomes. First, the vast majority of studies establishing a causa...

Any opinions expressed in this paper are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but IZA takes no institutional policy positions. The IZA research network is committed to the IZA Guiding Principles of Research Integrity. The IZA Institute of Labor Economics is an independent economic research institute that conducts research in labor economics and offers evidence-based policy advice on labor market issues. Supported by the Deutsche Post Foundation, IZA runs the world's largest network of economists, whose research aims to provide answers to the global labor market challenges of our time. Our key objective is to build bridges between academic research, policymakers and society. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author.